50+ Claims Associate Interview Questions and Answers

Health is the state of being physically, mentally, and socially well. Insurance is done to protect oneself from financial loss due to unexpected health issues.

• Health refers to the overall well-being of an individual, including physical, mental, and social aspects.

• Insurance is done to mitigate the financial risk associated with unexpected health issues.

• Health insurance provides coverage for medical expenses, hospitalization, and other related costs.

• Without insurance, individua...read more

Medicare and Medicaid are both government healthcare programs in the United States, but they serve different populations and have different eligibility criteria.

• Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as certain younger individuals with disabilities.

• Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families, including pregnant women, children, and people with di...read more

Copay, coinsurance, and out-of-pocket expenses are all terms used to describe the portion of medical costs that patients are responsible for paying.

• Copay is a fixed amount that patients pay for a specific medical service or prescription drug.

• Coinsurance is a percentage of the cost of a medical service that patients are responsible for paying.

• Out-of-pocket expenses are the total amount of money patients pay for medical services and prescription drugs that are not covered by in...read more

Insurance is a contract between an individual and an insurance company to protect against financial loss.

• Insurance provides financial protection against unexpected events such as accidents, illnesses, and natural disasters.

• Premiums are paid to the insurance company in exchange for coverage.

• There are different types of insurance such as health, auto, home, and life insurance.

• Insurance claims are filed when a covered event occurs and the insurance company pays out benefits.

• Insu...read more

Void claims are claims that are invalid or incomplete, Medicare has different types, denials can be based on various reasons, and OI types refer to other insurance types.

• Void claims are claims that are missing information or are incorrect, leading to rejection by the payer.

• Types of Medicare include Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).

• Types of denials can be based on eligibility, coverage...read more

Claims are requests made by policyholders to insurance companies for compensation for damages or losses incurred.

• Claims are requests for compensation for damages or losses

• They are made by policyholders to insurance companies

• Claims can be related to property damage, theft, accidents, or injuries

• Insurance companies investigate claims to determine their validity

• Valid claims are paid out to the policyholder

Legato is a term used in music to describe smooth and connected notes. Insurance is a contract between an individual or organization and an insurance company to provide financial protection against potential losses.

• Legato refers to playing or singing notes smoothly and without interruption.

• In insurance, individuals or organizations pay premiums to an insurance company in exchange for coverage against potential risks or losses.

• Insurance policies can cover various aspects such ...read more

Fraud and non-claim analyst deal with detecting and preventing fraudulent activities related to claims. Debit cards are linked to bank accounts for making electronic transactions. Different types of accounts include savings, checking, and money market accounts. Chargeback is a process where a transaction is reversed. There are various types of ATM cards for different uses.

• Fraud and non-claim analysts focus on identifying and preventing fraudulent activities in insurance claim...read more

I had to utilize multiple applications to process a claim for a customer who had both auto and home insurance policies.

• I accessed the auto insurance system to verify coverage and details of the claim.

• I then logged into the home insurance system to gather information on the property and any relevant policies.

• I used a claims processing software to input and track the details of the claim across both policies.

• I communicated with the customer through email and phone calls to gath...read more

Medicare is a federal program for seniors, while Medicaid is a state and federal program for low-income individuals.

• Eligibility: Medicare primarily serves individuals aged 65 and older, while Medicaid is designed for low-income individuals and families, regardless of age.

• Coverage: Medicare covers hospital care (Part A), medical services (Part B), and prescription drugs (Part D), whereas Medicaid offers a broader range of services, including long-term care and preventive servi...read more

Journal entry of drawings from own proprietary business

• Create a journal entry with the date of the transaction

• Debit the drawings account and credit the owner's equity account

• Include the amount of the drawings in the entry

• Example: On 1/1/2021, $500 was withdrawn from the business for personal use. Debit Drawings for $500 and credit Owner's Equity for $500

CHAMPVA is a healthcare program for eligible dependents of veterans, providing coverage for medical services and prescriptions.

• CHAMPVA stands for Civilian Health and Medical Program of the Department of Veterans Affairs.

• It is a comprehensive healthcare program for the dependents of veterans who are not eligible for TRICARE.

• CHAMPVA covers a wide range of medical services, including doctor visits, hospital stays, mental health services, and prescription medications.

• Eligible dep...read more

Various types of steel materials are used in the make of cars, including high-strength steel, mild steel, and advanced high-strength steel.

• High-strength steel is used for structural components to improve crash safety and reduce weight.

• Mild steel is commonly used for body panels and other non-structural parts.

• Advanced high-strength steel offers a good balance of strength and formability, making it ideal for various car components.

I expect a salary increase of 10% from my current CTC.

• I have researched the market rates for Claims Associates and based on my experience and skills, I believe a 10% increase is reasonable.

• I have consistently performed well in my current role and have received positive feedback from my superiors, which justifies the salary increase.

• I am confident that my skills and expertise will contribute significantly to the company's success, making me deserving of a higher compensation.

• I...read more

A copay is a fixed amount that an insured person pays for a covered healthcare service at the time of receiving the service.

• Copay is a form of cost-sharing between the insurance company and the insured individual.

• It is a predetermined amount that the insured person must pay out of pocket for each visit or service.

• Copayments can vary depending on the type of service, such as doctor visits, prescription drugs, or specialist consultations.

• For example, a health insurance plan may...read more

UB04 is a standard claim form used by healthcare providers to bill for services provided to patients in a facility setting.

• UB04 is also known as the CMS-1450 form

• It is used for billing Medicare, Medicaid, and private insurance companies

• The bill type field on the form indicates the type of service being billed, such as inpatient or outpatient

• The facility type field indicates the type of healthcare facility, such as hospital or nursing home

• The POS field indicates the place of s...read more

There are multiple types of claims in this process.

• There are claims related to property damage.

• There are claims related to bodily injury.

• There are claims related to liability.

• There are claims related to theft or vandalism.

• There are claims related to natural disasters.

• There are claims related to medical expenses.

• There are claims related to lost wages.

• There are claims related to death benefits.

Claims in insurance are requests for payment based on the terms of a policy after a loss or damage occurs.

• Definition: A claim is a formal request made by the policyholder to the insurance company for compensation for a covered loss.

• Types of Claims: Common types include property claims (e.g., damage to a home), auto claims (e.g., car accidents), and health claims (e.g., medical expenses).

• Claim Process: The process typically involves submitting a claim form, providing evidence ...read more

I developed an interest in maritime law through my passion for sailing and fascination with international trade.

• Growing up near the coast sparked my curiosity about maritime activities

• Studying international business in college introduced me to the complexities of maritime law

• Interning at a maritime law firm provided hands-on experience in the field

• Attending seminars and workshops on maritime law further deepened my interest

• Reading case studies and following landmark maritime ...read more

The URL borrower information form is a document used to collect personal and financial details of a borrower through an online link.

• The form typically includes fields for the borrower's name, contact information, employment details, income, and credit history.

• It may also request information about the borrower's assets, liabilities, and any co-borrowers or guarantors.

• The form is often used by lenders or financial institutions to assess the borrower's eligibility for a loan or ...read more

HIPAA (Health Insurance Portability and Accountability Act) is a US law that protects the privacy and security of patients' health information.

• HIPAA is an acronym for Health Insurance Portability and Accountability Act.

• It was enacted in 1996 to establish national standards for the protection of individuals' medical records and other personal health information.

• HIPAA applies to healthcare providers, health plans, and healthcare clearinghouses that transmit health information e...read more

Acid test ratio is a financial metric used to measure a company's ability to pay off its short-term liabilities with its current assets.

• Also known as quick ratio

• Formula: (Current Assets - Inventory) / Current Liabilities

• A ratio of 1 or higher is considered good

• Helps assess a company's liquidity and financial health

The answer is 540.

• To solve 30% of 1800, multiply 30/100 by 1800.

• 30/100 x 1800 = 540

Health care encompasses the prevention, diagnosis, treatment, and management of illness and the preservation of mental and physical well-being.

• Includes services like routine check-ups, emergency care, and surgeries.

• Involves various professionals such as doctors, nurses, and therapists.

• Can be delivered in settings like hospitals, clinics, and home care.

• Focuses on both physical health (e.g., treating injuries) and mental health (e.g., counseling).

• Public health initiatives aim t...read more

Sum adds all values in a range, while Sumif adds values based on a condition.

• Sum: =SUM(A1:A5) adds all values in range A1 to A5

• Sumif: =SUMIF(A1:A5,">3") adds values in range A1 to A5 where value is greater than 3

Options are choices or alternatives that are available to a person or organization.

• Options provide flexibility and allow for decision-making.

• Examples of options include different insurance policies, investment opportunities, or career paths.

• Options can also refer to financial instruments such as stock options or futures contracts.

A claim is a request for payment made by an individual or organization to an insurance company or government agency.

• Claims are made when an individual or organization experiences a loss or damage that is covered by their insurance policy.

• The claimant submits documentation and evidence of the loss or damage to the insurance company or government agency.

• The insurance company or government agency reviews the claim and determines whether it is covered by the policy or program.

• If ...read more